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Antimicrobials for Neonates: Practitioner Decisions and Diagnostic Certainty.
Naomi E Spotswood1,2,3, Erin Grace4,5,6, Peter A Dargaville3,7
1From the Women's, Children's and Adolescents' Health Program, Burnet Institute, Melbourne, Victoria, Australia.
The Pediatric Infectious Disease Journal
|February 25, 2025
Summary
Neonatal antimicrobial prescribing is complex, influenced by clinical factors and uncertainty. Improving guideline consistency and understanding medicocultural influences are key for better stewardship.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Clinical Pharmacology
Background:
- Antimicrobial use is common in hospitalized neonates.
- Factors influencing prescribing decisions and practice variations are not well understood.
Purpose of the Study:
- To investigate influences on antimicrobial prescribing decisions in Australian neonatal units.
- To assess practitioner confidence and diagnostic certainty in neonatal antimicrobial use.
Main Methods:
- Cross-sectional survey of 56 practitioners across 3 Australian neonatal units.
- Questionnaires evaluated diagnostic certainty and influences on 68 antimicrobial courses and 11 non-prescribed infection evaluations.
Main Results:
- High guideline adherence (84%) at commencement.
- Clinical factors, signs, and labs varied in impact; colleague consultation influenced decisions.
- Practitioner confidence varied, especially in non-confirmed infections; team concordance was low (14-50%).
Conclusions:
- Antimicrobial prescribing is influenced by clinical, laboratory, practitioner, team, and center-specific factors.
- Clinical uncertainty and guideline variability contribute to practice variation.
- Future stewardship requires consistent guidelines, better diagnostic aids, and understanding medicocultural influences.
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